Strabismus surgery

[nydanny]

Anyone have any experience with strabismus surgery? How was it? Are you happy with the results? My right eye has hypertropia (it looks to be half a millimeter higher). I plan on getting surgery to have my eyes aligned after i graduate from college because i hate wearing the prism glasses and i get depressed all the time because of my eye misalignment.

[John C Hagan III, MD, FACS, FAAO]

JCHIIIMD

[summerluvr]

I have congential strabismus.  Twice corrected sugically.  The first surgery i had when i was about 2.  I remember as a kid having to wear a patch off and on a few times on my good eye to try and strengthen my bad one.  This is the only kind of "vision therepay" i recall ever doing.  

My eye started drifting in my teens and by 19-20 was very turned in, noticeable even through glasses.  As soon as i took my glasses off it was very turned.

I had it surgically corrected for the second time 3 years ago and The Dr. did a fantastic job.  Its nearly perfect.  It will turn more if i'm tired, etc.  I do still have some tracking problems, but that can't be fixed.  

I recomend just getting it done if you can.  Its a simple day surgery (in in the morning, home at night) and they can fine tune is with a sliding stich to get a great result in adults. The pain was a bit for a week or so, but i had a slight complication with the stitch.  Most people only have pain a couple days.  I'm glad i got it corrected a second time.  

[JodieJ]

Dr. Hagan, given your experience with parents who have wasted thousands of dollars on useless treatment, I can certainly understand your feelings about vision therapy.  There is pitifully little research demonstrating the efficacy of this modality.  To further muddy the waters, I suspect that most vision therapy is done with children who may be less than highly motivated.

I had no idea that the vision therapy computer program I was given was designed to treat convergence insufficiency (and my problem was divergence).  The manual said to be "patient and persistent," so I persisted in my attempts to pass divergence tasks despite dozens of failures.  During the six weeks between the date I started the vision therapy program and the date of my strabismus surgery (and MANY hours of practice), I made significant progress in terms of reducing the degree of my esotropia.  My surgeon was truly shocked; I guess he expected that I'd just give up on vision therapy.  It's unknown how much my divergence skills would have regressed without continued practice, or what I might have accomplished with continued effort (and without the benefit of surgery).

I'd strongly recommend that nydanny follow through on his plan to consult a strab surgeon.  He has so much to potentially gain from a minor procedure.  Nor would I recommend that anyone invest substantial money in vision therapy.  But based on my personal experience, I'm not ready to dismiss this modality as a reasonable option in some (but which?) situations.

  

[John C Hagan III, MD, FACS, FAAO]

The only type of "visual training" that is supported by evidence based medicine is convergence fusion exercises for convergence insufficiency. However using "pencil push-ups" is just as effective as more expensive computer exercises. Moreover like doing any exercise if the its stopped usually the convergence amplitudes regress.

The above probably accounts for 5% of visual training done in the US. The rest of it is completely unsubstantitated for benefit. I have had parents spent $5000-$10000 on useless visual care therapy.

JCH III MD Eye Physician & Surgeon

[JodieJ]

I had strabismus surgery two years ago at age 51 after suffering for several years from increasingly lengthy episodes of double vision at distance.  (I developed the condition from monovision contact lens wear; apparently I had a mild phoria which decompensated under the stress of monovision.  But my condition had been misdiagnosed by several eye care professionals.)  I finally got some symptom relief from 6 PD of base out prism in my glasses, but I still wasn't happy.  I found an excellent strabismus surgeon in a Castle-Connolly directory (www.castleconnolly.com).  My adjustable suture surgery was totally painless, and it completely eliminated my problem.  A few hours after surgery I went shopping at the mall (wearing sunglasses), and I could drive the next day.  My co-pay to the surgeon was only about $150; I wrote "WINNER:  BEST BUY OF 2005" in red marker on the statement that I mailed back with my check.

By the way, my strabismus surgeon actually gave me a home computer vision therapy program during my first visit (which was abbreviated due to the surgeon's unexpectedly heavy schedule that day).  The program contained vergence fusion exercises, and I was actually able to improve my divergence ability after a few weeks of practice.  I did some research about vision therapy, and I do believe that it can be helpful for mild/moderate exotropia and (to a lesser degree) mild/moderate esotropia.  There is no evidence (that I could find) that vision therapy can help hypertropia, learning disabilities, myopia, presbyopia, etc.    

[nydanny]

I've been doing vision therapy for a year and my eyes have gotten better, but I want them to be perfectly aligned.

[John C Hagan III, MD, FACS, FAAO]

Hello nydanny   I suggest you see a ophthalmologist that specializes in strabismus (eye alignment disorders) usually the are called Pediatric ophthalmologists since most strabismus is in childhood but most also do adult strabismus. Only an evaluation by this type of Eye MD can tell you whether surgery will help. I suggest you do it soon. Most strabismus specialists DON'T belive in visual therapy--it's expensive and not proven by evidence based medicine. It is a profit center for non-physician, limited scope eye care providers (optometrists-they have OD after their name).

JCH III MD Ophthalmologist  
To: